The writer is the author of “Extra Time”, and advises the UK Department of Health and Social Care
If there was ever a story to brighten our corona winter and ram home the message that not all 70-somethings are the same, it is that of Graham Walters. Aged 72, Mr Walters set out for Antigua in January, in a boat he built in his garden in Leicestershire. By rowing solo across the Atlantic, he broke three world records. But he has landed in a totally different world, one in which he could now be condemned to grey lockdown because of his age.
Two months ago, UK prime minister Boris Johnson announced that the over-70s, pregnant women and those suffering serious health conditions should avoid all social contact for 12 weeks. That made sense at the time, because it was clear that Covid-19 hits the oldest hard. But a proposal to extend restrictions on all over-70s when the UK eases lockdown from this Sunday, lumps pensioners together in a way that feels unjust — and unscientific.
I do not underplay the risks of age. The explorer Robin Hanbury-Tenison, surely one of the fittest 83-year-olds on the planet, has only narrowly survived the virus after 49 days in hospital. Still, age is a blunt indicator. Almost half of Covid-19 patients in NHS intensive care units last week were under 60, and most of those whose cases turn critical have chronic health conditions.
We know that men appear to suffer worse from the virus than women and that obesity is a significant risk factor. But no one is suggesting that fat men should stay in quarantine longer than everyone else. While the World Health Organization identifies being over 60 as a key risk factor in this pandemic, there seems to be a steep age gradient. South Korean data suggest the risk of dying is 1.8 per cent in patients aged between 60-69, 6.3 per cent for those aged 70-79, and a whopping 13 per cent for the over-80s. We don’t yet know how much of this increase is purely due to age, versus the chronic diseases the elderly are more likely to suffer.
All of this matters, because over the past 20 years there has been a dramatic decoupling of chronological from biological age. Some people are physiologically “old” at 60; others spry at 80. Japanese gerontologists talk about the “young-old” — citizens between 60 and 75 so much fitter than previous generations that they are a different physiological tribe. In the US, a group of septuagenarian joggers were found to be 30 years biologically younger than their sedentary peers, with stronger muscle mass and immune systems. Will Covid-19 attack them equally?
Frustratingly, researchers show little interest in trying to find out. They routinely lump all pensioners together, as does society. Much of the language around shielding and isolation portrays older people as helpless victims. Yet only two months ago many were pillars of their communities, picking up grandchildren from school, running pubs, and manning phone lines for the same mental health services that they may soon need in the quiet desperation of enforced isolation.
Having spent three years researching the young-old, I have a Rolodex unusually weighted with septuagenarians. Some are world experts in fields ranging from biology to finance. Many are passionate exercisers, who very much want to get back to their day jobs. None wish to burden their families or the NHS. Those with underlying health conditions are very unlikely to take foolish risks; they will use their common sense.
On Sunday, the prime minister will announce plans to reopen the economy while trying to avoid an overwhelming second wave of infection. In his in-tray is a proposal for the government to relax restrictions on 60 per cent of the UK population while extending the lockdown for the vulnerable and everyone over 70. The modelling assumes the relative risk of severe disease in this group is 16:1. But it makes no attempt to stratify risk within the over-70s.
We need more transparency about the conditions that make us vulnerable. The current UK guidance is that everyone over 70 is “clinically vulnerable”, regardless of medical conditions. This puts them one step down from the 1.5m “extremely critically vulnerable” people being “shielded”, with food parcels delivered to their homes.
Age UK worries that this language is confusing. It also worries about the effect of isolation on people who had lived independently but now struggle without social networks. “They are on no one’s list,” says Caroline Abrahams, the group’s charity director. This invisible group is not on community WhatsApp groups, and exists in the public imagination only as “old dears” who should keep out of the way while the rest get back to normal. The price of that could be high.
One advantage of age is wisdom and perspective. The jolliest care home I’ve ever visited is in the Netherlands where college students live with the residents. The board tried to stop this, warning that students might infect the place with “sex, drugs and rock ’n’ roll”. But the manager told me, her eyes glinting, “my residents have all brought up families. They’ve made tough decisions. They know about sex, drugs and rock n’roll”.
Many over-70s will continue to take extensive precautions, whatever the government does. But the fittest may prefer to do the school run, allowing others to return to work, and keep up a stringent exercise regime. Mr Johnson is aware of this. “Millions of active people over 70 may feel . . . there is something excessive about these measures,” he said in March. What he should do now is to treat older people like the grown-ups they are: level with them about the facts, and ask scientists to stop assuming everyone is equally “old”.
